Venous Thromboembolism Rates Did Not Decrease in Lower Extremity Revision Total Joint Arthroplasty From 2008 to 2016

Jun 3, 2019The Journal of arthroplasty

Blood Clot Rates Did Not Drop After Lower Leg Joint Replacement Surgeries Between 2008 and 2016

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Abstract

Approximately 1 in 83 patients undergoing revision total knee arthroplasty (rTKA) and 1 in 100 patients undergoing revision total hip arthroplasty (rTHA) experienced a venous thromboembolism (VTE) within 30 days post-surgery.

The overall 30-day incidence of VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality for rTKA were 1.2%, 0.9%, 0.4%, and 0.5%, respectively.
For rTHA, the incidences were 1.0% for VTE, 0.7% for DVT, 0.4% for PE, and 0.7% for mortality.
No significant changes in VTE, DVT, and PE incidences were observed over the study period from 2008 to 2016 for either rTKA or rTHA.
A significant decrease in mortality was noted in rTHA patients over the study period (P = .010).
Further research is needed to develop optimal individualized prevention strategies for VTE in rTKA and rTHA.

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BACKGROUND: In revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA), venous thromboembolism (VTE) has been reported to be a relatively common and potentially serious complication. To mitigate this risk, strategies such as rapid recovery programs and thromboprophylaxis guidelines have been utilized. This study sought to identify the annual incidence and recent trends of VTE (defined as the presence of deep vein thrombosis [DVT] and/or pulmonary embolism [PE] in the same patient), DVT, PE, and mortality in the 30-day period after rTKA and rTHA.

METHODS: We identified 30,406 rTKA and rTHA patients from 2008 to 2016 using the National Surgical Quality Improvement Program database. Thirty-day incidences for VTE, DVT, PE, and mortality for each year and the overall study period were calculated. Bivariate and multivariate regressions were performed using patient demographics and comorbidities to assess trends in the outcomes of interest.

RESULTS: The overall incidences of 30-day VTE, DVT, PE, and mortality for rTKA were 1.2%, 0.9%, 0.4%, and 0.5%. Bivariate analysis revealed no significant change over the study period for VTE (P = .137), DVT (P = .406), PE (P = .121; 99% confidence interval 0.112-0.129), and mortality (P = .463). The incidences over the study period of VTE, DVT, PE, and mortality in rTHA were 1.0%, 0.7%, 0.4%, and 0.7%. Bivariate analysis revealed no changes in VTE (P = .393), DVT (P = .376), and PE (P = .602). However, bivariate analysis revealed significant decrease in mortality (P = .010) over the study period.

CONCLUSION: Within 30 days of surgery, approximately 1 in 83 rTKA patients and 1 in 100 rTHA patients experienced a VTE. Furthermore, the rates of VTE remained largely unchanged from 2008 to 2016. Further research regarding the optimal individualized prophylaxis algorithm in rTKA and rTHA is warranted to prevent this complication. This study represents the first investigation of thromboembolic events in rTHA and rTKA.

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Venous Thromboembolism Rates Did Not Decrease in Lower Extremity Revision Total Joint Arthroplasty From 2008 to 2016

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